Published byStanford Medicine

Parenting

Remember being drilled multiplication tables? Or taking a timed math exam? These have been common activities in school, but Stanford experts say they’re not really helpful to kids learning math facts. In fact, they deter students who might otherwise be excellent mathematicians.

Jo Boaler, PhD, is a professor of mathematics education and lead author on a new working paper, “Fluency without Fear.” As part of the research, educators looked at MRI scans of students who are better and worse at math memorization. The only difference in the brain shows up in the hippocampus, the working memory center, leading researchers to believe that there are no differences in math ability, analytical thought, or IQ between the groups. Moreover, the working memory shuts down when under stress. This makes it harder to recall facts when under time pressure, and seems to particularly affect high-achieving and female students.

Boaler’s research shows that students are better at math when they’ve developed “number sense,” or the ability to use numbers flexibly and understand their logic, which comes from relaxed, enjoyable, and exploratory work. Investigators found that high-achievers actually use number sense, and not rote memorization; likewise, it’s not that low-achieving students know less, but that they don’t use numbers flexibly.

Boaler told Stanford News, “They have been set on the wrong path, often from an early age, of trying to memorize methods instead of interacting with numbers flexibly… Number sense is the foundation for all higher-level mathematics.”

So, good math students are not necessarily fast math students, which is a common misconception. In fact, many mathematicians are slow with numbers, because they think carefully about them. The danger is that kids who aren’t fast with math sometimes become convinced they’re not good at it, and they turn away.

Compare times-tables drilling with how English is commonly taught. Students learn words by using them in many different settings: reading novels or poetry, writing thoughtful pieces, speaking about their thoughts or observations. “No English student would say or think that learning about English is about the fast memorization and fast recall of words,” says Boaler.

Boaler teaches a class for educators, “How to learn math,” in which she encourages a variety of math activities, including those that focus on the visual representation of number facts. Visual and symbolic number associations use different pathways in the brain, and connecting them deepens learning, as shown by recent brain research.

A wave of changes in state laws on the use of marijuana for medicinal and recreational purposes has stirred the American Academy of Pediatrics. It’s taken 10 years for the AAP to update its policy on the legalization of marijuana, and they released its new one on Monday.

The organization still opposes legalization but it has opened the door to reform in several ways. First, recognizing that minority kids bear the brunt of criminal penalties for pot use, they call for decriminalization. Second, they call for the U.S. Drug Enforcement Agency to reclassify marijuana from a Schedule 1 listing for controlled substances to a Schedule 2. This action would effectively allow more research to be conducted and in turn scientifically determine where marijuana is most effective as a treatment. A review by the federal government is currently underway.

I asked Stanford pediatrician Seth Ammerman, MD, the lead author of the statement, what the AAP was trying to achieve with its policy redo and why such a restrictive stance on legalization since the train for legalization – recreational and medicinal – seems to have already left the “coffee house.”

In this 1:2:1 podcast, Ammerman cites major two concerns. First, if legalized and commercialized, marijuana will become a big business, and the same marketing efforts by tobacco companies that encouraged teens to take up cigarettes will lasso them to pot smoking. “Well, aren’t kids smoking pot already?” I asked. Ammerman fully realizes that any teen who wants pot can readily buy it – legalization, to the AAP, is an imprimatur. Secondly, Ammerman cited, as does the new policy statement, the compelling and growing scientific evidence that the brain in formation continues to gel through the teen years and into the 20s. Marijuana, just like alcohol and any other drug, is likely to play a lot of bad tricks as the prefrontal cortex solidifies.

New research has also demonstrated that the adolescent brain, particularly the prefrontal cortex areas controlling judgment and decision-making, is not fully developed until the mid-20s, raising questions about how any substance use may affect the developing brain. Research has shown that the younger an adolescent begins using drugs, including marijuana, the more likely it is that drug dependence or addiction will develop in adulthood.

Ammerman says that the AAP will follow closely what happens in states where marijuana has been legalized both for health and recreation, and it will look carefully at what future evidence suggests. Clearly, there’s still a lot of smoke around this issue.

As a parent, this Time headline immediately grabbed my attention: “Mindfulness Exercises Improve Kids Math Scores.” But as I read the article, I learned that math scores were just one facet examined by the researchers and that mindfulness training was also shown to help children be less stressed and more caring.

The study, which was published in this month’s issue of Developmental Psychology, looked at a group of 99 fourth and fifth graders in British Columbia. For four months, half of the students were taught a pre-existing “personal responsibility” curriculum, while the rest learned about mindfulness through a program called MindUP that focuses on breathing exercises, mindful smelling and eating, and gratitude. The researchers then looked at cortisol levels, behavioral assessments, self-reports, along with those math scores. The article describes the results in more detail:

The results were dramatic. “I really did not anticipate that we would have so many positive findings across all the multiple levels we looked at,” says study co-author Kimberly A. Schonert-Reichl, a developmental psychologist at the University of British Columbia. “I was very surprised,” she says—especially considering that the intervention took place at the end of the year, notoriously the worst time for students’ self-control.

Compared to the kids in the social responsibility program, children with the mindful intervention had 15% better math scores, showed 24% more social behaviors, were 24% less aggressive and perceived themselves as 20% more prosocial. They outperformed their peers in cognitive control, stress levels, emotional control, optimism, empathy, mindfulness and aggression.

Newborns are especially vulnerable to severe complications from the disease, so doctors suggest that anyone who’s going to be in close contact with newborns and isn’t up-to-date also get a booster: fathers, siblings and even visiting grandparents. The strategy is called “cocooning.”

But what do you do when a grandparent doesn’t want to get a shot? A lot of people don’t like getting vaccinations, either because they want to avoid the discomfort of a shot in the arm or they don’t believe vaccines are effective. (They are.) It’s a question that comes up more often than I expected in online communities. Many pregnant women insist that grandparents who won’t get pertussis shots won’t be allowed to see the new grandchild. Others argue that you can’t force a medical decision like that on someone else. Throw in the added complication that if you’re a first-time parent, it might be the first time you’ve had to confront your parents about how you plan to raise your child. What a mess.

I’m lucky that most of my daughters’ grandparents are already vaccinated for pertussis: My parents and my mother-in-law came to stay and help us with the baby a few years ago and all got vaccinated at the time. But with all the things occupying us as new parents, we didn’t even think to ask my father-in-law, who lives nearby but didn’t have any extended stays in our home. As it turns out, he’s not a fan of vaccinations, and he insists that he got the flu from his last flu shot. (He didn’t.) Obviously, he hadn’t gotten the pertussis booster.

For this baby, we’re planning on bringing up the shot with him, but we’re not expecting him to actually get one. So what will we do? I surprised myself by deciding that I won’t insist he get one in order to see the baby, as long as he doesn’t have any cold symptoms when he visits. (Pertussis usually starts as a mild cold that gets progressively worse; by the time most people are diagnosed, they’ve been sniffling and shedding pertussis bacteria for weeks since they first showed symptoms.) But, who knows? Maybe Grandpa Lesko will surprise us and get the shot for the baby’s sake – or just to avoid the sniffle quarantine policy.

The past century has been flooded with trends and new information surrounding pregnancy, birth, and infant care. From doctors Spock, Lamaze, and Bradley in the ’50s, to the promotion of new technologies such as epidural anesthesia and formula feeding in the ’60s, through various iterations of the natural birth movement in the 70’s and 80’s… From the licensing of non-hospital midwives in the 90’s, to the boom in doulas in the 2000s, through the proliferation of maternity apps in this decade, the “right way” to bring a baby into the world has evolved.

To get grandparents updated on their baby knowledge, Lucile Packard Children’s Hospital sponsors a “Grandparents’ Seminar” as part of its course offerings. As a recent San Francisco Chroniclearticle notes,”Hospitals commonly offer classes in labor, lactation and baby CPR. But adding grandparents to the mix is a modern twist. It used to be that grandparents didn’t go to classes for advice. They dispensed it.”

The two-hour course covers infant safety, sleep, and feeding. Though most of the class participants were conscientious and up-to-date when they were raising their own children, some accepted practices have changed – babies are now swaddled tightly like burritos, laid to sleep on their backs without pillows, and exclusively breastfed when possible. Umbilical cords are cleaned with water instead of alcohol, the specifications for car seats have changed dramatically, and there is a potentially overwhelming array of new products on the market. Medical communities are increasingly becoming aware of perinatal mood disorders, and informing patients about practices that were once “fringe” – like co-sleeping and intervention-free birth.

The course also touches on the complex emotional issues that come with becoming a grandparent, and offers advice on etiquette – which the course instructor, Marilyn Swarts, a labor and deliver nurse and nurse manager quoted in by the Chronicle, sums up with “Seal your lips.” Parents want their parents involved with the baby, but they also want autonomy and to incorporate modern care practices. Indeed, many people who take the course learned about it through their children.

Swarts has been teaching the course for the nearly ten years it has been offered. In a 2009 interview with a grandparenting blog, she said:

It’s so hard because we’re still in the parent mode and just want to help our children, but they must learn for themselves. Better to ask them: What do you think would be a good solution? I want grandparents to empower the new parents, help them believe they’re the best parents for their child and make them feel comfortable and confident in their new roles.

Regular physical activity during pregnancy has been shown to benefit both mom and baby: Past studies found that exercise can help expectant mothers manage weight gain, sleep better, improve circulation and reduce swelling or leg cramps and increase their endurance in preparation for childbirth. A growing body of evidence also suggests that maternal exercise can boost babies’ brain development and influence a child’s health into adulthood.

Now findings (subscription required) published in the Journal of Sports Medicine and Physical Fitness show that by exercising, moms may reduce their children’s risk of developing high blood pressure, or hypertension. The Michigan State University researchers say their findings are significant because earlier studies have shown babies with low birth weight are more likely to have poor cardiovascular health and an increased risk of hypertension. PsychCentral reports:

[Researchers] initially evaluated 51 women over a five-year period based on physical activity such as running or walking throughout pregnancy and post-pregnancy.

In a follow up to the study, they found that regular exercise in a subset of these women, particularly during the third trimester, was associated with lower blood pressure in their children.

“This told us that exercise during critical developmental periods may have more of a direct effect on the baby,” [said lead author James Pivarnik, PhD].

The finding was evident when his research team also discovered that the children whose mothers exercised at recommended or higher levels of activity displayed significantly lower systolic blood pressures at eight to 10 years old.

“This is a good thing as it suggests that the regular exercise habits of the mother are good for heart health later in a child’s life,” Pivarnik said.

My grandmother is fortunate enough to live within an easy drive of the Shady Maple Smorgasbord, a Pennsylvania Dutch-style dining extravaganza in Lancaster County. It’s the size of a large auditorium, packed with tables and two gigantic buffet lines. It’s the biggest restaurant, serving the most food, to the most people, that I’ve ever seen.

Not so fast, Stanford-based dietician, Maya Adam, MD, would say. “Size matters. We can enjoy absolutely any food, as long as its consumed in moderation,” she writes in a Healthier, Happy Lives Blog post, published today by Stanford Children’s Health.

That means no King Size KitKat and no seconds at the smorgasbord dessert line, either. Try using smaller dishes, Adam suggests. Cut servings in half, eat half, save some for later or share with a friend. And pay attention to the food. No texting, TV watching or mindlessly shoveling food into your mouth. Savor each bite, Adam writes:

The truth is, when we eat real, fresh food in modest amounts (even if it’s cooked with a pat of butter and a sprinkle of salt) it doesn’t take much to leave us feeling completely satisfied.

Don’t flip out if you just can’t resist that smorgasbord. But practice moderation — that’s the real way to think big about food.

The holiday season is often a joyful time when friends and family hit pause on their busy schedules to enjoy each other’s company. There’s also lots and lots of food involved, which can be challenging for parents with a history of eating disorders.

Recent research has found that parental eating disorders (either a past or current condition) are associated with numerous problems in child feeding, including difficulties in transitioning to solid foods and deciding which types of foods to offer and in what quantities. Studies observing the interactions of mothers with eating disorders and their young children noted greater conflict and more controlling behavior over eating, appetite, and food choices. Mothers with eating disorders often tell researchers and clinicians that their children’s troubling eating patterns are associated with their own eating habits, and shape and weight concerns too often intervene in the decisions parents make in feeding their children.

Holiday celebrations can make these feeding relationships even more complex. Traditions of eating together with family or friends may create additional stress for parents. Additionally, family gatherings can reawaken memories of negative experiences parents may have had as children at the dinner table, adding another layer of worry and hyper-vigilance.

So what should parents with a history of eating disorders, or those concerned about their children overeating, do during the holidays? Here are some tips for having a more pleasurable and relaxing time:

Plan ahead: Talk to your partner about your concerns and come up with a strategy for how to cope with stressful situations around eating. Talk about what you’ll do if there is food on the table that you typically don’t eat, or if your child asks for second and third servings of foods. A rule of thumb should be to allow the child to experience a variety of food to a certain extent, as long as it doesn’t contradict any significant beliefs or preferences (such as non-kosher food).

Talk with your child before things get out of hand: Walk your child through the social gathering beforehand and discuss potential conflicts that may arise. The discussion should be appropriate to the child’s age. With children ages 2-3, parents could talk about the meal, mention that it will be probably very tasty, and set some limits. For instance, one could say that after dinner the child can have one or two desserts, but not more. With older children, parents should encourage autonomous eating based on the child’s regulation of hunger and satiety. This is an opportunity to discuss with children the differences between families, as well as your normal routine and special events. You should also discuss general boundaries and choices of your household.

Add fun activities that don’t involve food: Many celebrations and traditions revolve around food. To participate with your family in more neutral activities that are less nerve-wracking, parents should think of supplementary pastimes that all family members will enjoy. Shifting the focus away from the meal for part of the time can help parents “lower the volume” of their eating disorder when they spend time with their children.

Unwind: Despite being worried that loved ones will gain excessive weight during the holidays, parents should remind themselves that in a healthy-eating style, people don’t become overweight following a few specific meals. In addition, you should focus on the positive aspects of the social gathering for them and for their children – meeting family members or friends you may have not seen in a while, catching up with things you do not have time for during the year, and strengthening your relationships with your children. Before anxiety-provoking situations, parents should use any method of relaxation and stress-reduction that works for them and fits the context – have a long relaxing shower, drink a hot tea, listen to music, or stay away from the dinner table until the meal begins.

The holiday season can be a better experience for you and your family once you work through and resolve any concerns involving children’s eating.

Shiri Sadeh-Sharvit, PhD, is a psychologist and a visiting instructor at Stanford. She’s now recruiting mothers with a history of eating disorders to a parenting program study at Stanford. For more information contact shiris@stanford.edu.

Some areas of the brain grow more slowly in children with Type 1 diabetes than those without, according to findings published this week in Diabetes. Researchers also found that children with the highest and most variable blood sugar levels had the slowest brain growth.

Glucose, the main form of sugar in our blood, is the brain’s primary fuel, and in Type 1 diabetes, the body loses the ability to produce a key hormone needed to regulate blood sugar levels. Type 1 diabetes treatment for children has often focused on making sure their glucose levels don’t get too low, since very low glucose can quickly put someone into a coma. But it’s emerging that chronically-high sugar is also bad for the brain.

The better the glucose control, the more likely that a child’s brain development will be unimpeded.

The new study, conducted at Stanford and four other universities, tracked brain structure and cognitive function in 144 young children with Type 1 diabetes and a comparison group of 72 children without diabetes over 18 months. MRI scans showed that the brains of both groups of kids were growing, but gray- and white-matter growth was slower in several areas of the brain in the diabetic children.

“These studies provide strong evidence that the developing brain is a vulnerable target for diabetes complications,” the researchers wrote. The affected brain areas have a variety of roles, including visual-spatial processing; auditory, language and object processing; executive function; spatial and working memory; and integration of information from sensory systems.

I asked two of the paper’s Stanford authors for more thoughts about what they found.

“The magnitude of the group differences in brain growth over time was surprising,” said Allan Reiss, MD, the study’s senior author. “I actually thought these differences would be more subtle — they were not.”

Past studies have found cognitive and brain-structure changes associated with diabetes in older patients, but this research stands out because the kids included were so young — at the start of the study, their ages ranged from 4 to just under 10, with an average age of 7 — and because the study had a prospective design, following children forward in time. In addition to examining brain structure, the researchers also tested the kids’ cognitive function with standard tests of IQ, learning and memory, and mood and behavior, among others. They saw no significant differences in cognitive function between the two groups, a finding Reiss said did not surprise him.

Three Stanford graduates have an idea that could dramatically impact the daily life of active breastfeeding women: They plan to design and build a breast pump that is discreet, intuitive, and supportive of mothers. This may sound obvious, but nothing like it currently exists. In August of this year, Cara Delzer, MBA; Gabrielle Guthrie, MFA; and Santhi Analytis, PhD, founded Moxxly, “a consumer products company designing for women.” They’re in the final stretch of their 16-week incubation with Highway 1, which helps hardware startups move from a concept to a prototype ready for production.

“We’ve talked to women, hundreds of women, who have told us things like ‘pumping makes me feel like a cow,'” shares Delzer, Moxxly’s CEO, who I interviewed in late November. So she and her colleagues are aiming to re-imagine the pumping experience.

Delzer experienced the current, poorly-imagined pumps firsthand after the recent birth of her child: “I just remember watching my husband take piece after piece out of the pump box for the first time thinking, how in the world am I going to put this together? All those pieces, and clean them? I was already overwhelmed as a new mom, but completely overwhelmed by the pump.” Once she went back to work, she found that she was spending 25 percent of her day dealing with the logistics of pumping – mentally integrating it into her schedule, worrying about having all the parts. The experience is similar for many of today’s busy, mobile moms.

Meanwhile, Guthrie was at Stanford developing her passion for designing for women, Delzer recounts. “A lot of things that have been designed for women and girls in the past have followed this ‘shrink it and pink it’ trope where you literally make it smaller and bright pink and think, ‘Oh, now the girls will buy it.’ Well, Gabrielle doesn’t buy it.” For her masters’ thesis, Guthrie interviewed working moms, and the breast pump kept coming up as something that needed to be redesigned. She spent much of her last year at Stanford working on just that. At a hackathon, she and Analytisworked together to put the new designs into practice, and Analytis, whose PhD is in mechanical engineering, was hooked on solving this problem as well.

The three women “got together, looked one another in the eyes and said, ‘Do we believe this is a problem? Do we believe we can solve it? Do we believe the time is now?’ And it was yes, yes, yes,” said Delzer. They took on the challenge despite the fact that the breast pump is an FDA-regulated medical device and they will face a lengthy review process. They invented the name “Moxxly” with the intent of conveying spunkiness and strength, and incorporated XX to signify women.